Expandable implant

ABSTRACT

An expandable implant ( 100, 150, 160, 200, 250, 300, 400 ) has a base ( 10 ) and a displaceable element ( 12 ) hingedly interconnected at one end. At the other end, the base and the displaceable element are formed with complementary jaws ( 24, 26 ) which provide continuous overlap of facing surfaces over a range of angular positions of the displaceable element relative to said base. In some cases, the first end portion ( 16 ) of the displaceable element ( 12 ) is formed with projecting teeth ( 28 ) forming a partial gear centered on an axis ( 18 ) of the hinged interconnection with the base ( 12 ) for engaging a worm gear. In certain embodiments, the base is formed with a socket ( 30 ) for removably receiving a worm gear tool ( 32 ) for engaging the teeth ( 28 ) and displacing said displaceable element. After expansion, the worm-gear tool ( 32 ) can be removed.

FIELD AND BACKGROUND OF THE INVENTION

The present invention relates to expandable implants and, in particular,it concerns an implant formed primarily from two hingedly-connectedelements which maintains an enclosed internal volume as it expands.

In the field of minimally invasive spinal surgery (MISS), it is known toemploy various implants which assume a compact form for insertion via asmall incision into the body, and then expand to assume a largerdeployed state within the body.

Many expandable implants have relatively complex mechanisms, includingnumerous moving parts which must be assembled carefully, potentiallyleading to increased costs and/or reduced reliability. Complex designsalso pose particular challenges for surgical approaches which require ahigh degree of miniaturization.

Simpler designs, on the other hand, may fail to define a closed shapesuitable for filling with filling material.

SUMMARY OF THE INVENTION

The present invention is an expandable implant.

According to the teachings of an embodiment of the present inventionthere is provided, an expandable implant comprising: (a) a baseextending from a first end portion to a second end portion; and (b) adisplaceable element extending from a first end portion to a second endportion, wherein the first end portions of the base and the displaceableelement are hingedly interconnected, and wherein the second end portionsof the base and the displaceable element are formed with complementaryjaws, the complementary jaws being configured to provide continuousoverlap over a range of angular positions of the displaceable elementrelative to the base.

According to a further feature of an embodiment of the presentinvention, the complementary jaws provide complementary facing arcuatesurfaces.

According to a further feature of an embodiment of the presentinvention, the complementary jaws provide complementary facing surfacescorresponding to solids of revolution about an axis of the hingedinterconnection.

According to a further feature of an embodiment of the presentinvention, a first jaw of the complementary jaws comprises at least oneprojecting portion that is interposed between inward facing surfaces ofa second of the complementary jaws.

According to a further feature of an embodiment of the presentinvention, the inward facing surfaces are integrated with an end wallsuch that the inward facing surfaces and the end wall encompass the atleast one projecting portion on three sides.

According to a further feature of an embodiment of the presentinvention, the complementary jaws are configured to provide thecontinuous overlap over a range of angular positions of the displaceableelement relative to the base spanning at least 10 degrees, and in somepreferred cases at least 20 degrees.

According to a further feature of an embodiment of the presentinvention, the first end portion of the displaceable element is formedwith a plurality of projecting teeth configured as a partial gearcentered on an axis of the hinged interconnection with the base, theprojecting teeth being configured for engaging a worm gear.

According to a further feature of an embodiment of the presentinvention, the first end portion of the base is formed with a socketconfigured for removably receiving a worm gear tool for engaging theteeth and displacing the displaceable element.

According to a further feature of an embodiment of the presentinvention, the displaceable element is displaceable relative to the basefrom an initial position defining a compact configuration of theexpandable implant towards a deployed position defining an expandedconfiguration of the expandable implant, and wherein the complementaryjaws are formed with complementary parts of a retention configurationconfigured for inhibiting return of the displaceable element towards theinitial position.

According to a further feature of an embodiment of the presentinvention, the retention configuration comprises at least one sequenceof ratchet teeth deployed to inhibit return of the displaceable elementfrom a range of positions of the displaceable element towards theinitial position.

According to a further feature of an embodiment of the presentinvention, the retention configuration comprises two resilient retentionelements separated by a slot, and wherein the retention configuration isconfigured such that, on insertion of a prising tool into the slot toincrease a spacing of the slot, the retention configuration is releasedto allow displacement of the displaceable element towards the initialposition.

According to a further feature of an embodiment of the presentinvention, there is also provided a worm gear rotatably deployed withinthe first end portion of the base in engagement with the teeth such thatrotation of the worm gear effects displacement of the displaceableelement, wherein the worm gear is a hollow worm gear formed with anaxial through-bore for introduction of filling material via the axialthrough-bore into the expandable implant.

According to a further feature of an embodiment of the presentinvention, the second end portion of the base is formed with an aperturealigned with the worm gear so as to allow insertion of a tool throughthe aperture to engage the worm gear for rotating the worm gear.

According to a further feature of an embodiment of the presentinvention, there is also provided a worm gear rotatably deployed withinthe first end portion of the base in engagement with the teeth such thatrotation of the worm gear effects displacement of the displaceableelement, and wherein the second end portion of the base is formed withan aperture aligned with the worm gear so as to allow insertion of atool through the aperture to engage the worm gear for rotating the wormgear.

There is also provided according to the teachings of an embodiment ofthe present invention, an expandable implant comprising: (a) a baseextending from a first end portion to a second end portion; and (b) adisplaceable element extending from a first end portion to a second endportion, wherein the first end portions of the base and the displaceableelement are hingedly interconnected, and wherein the first end portionof the displaceable element is formed with a plurality of projectingteeth configured as a partial gear centered on an axis of the hingedinterconnection with the base, the projecting teeth being configured forengaging a worm gear, and wherein the first end portion of the base isformed with a socket configured for removably receiving a worm gear toolfor engaging the teeth and displacing the displaceable element.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention is herein described, by way of example only, withreference to the accompanying drawings, wherein:

FIG. 1A is an isometric view of an expandable implant, constructed andoperative according to an embodiment of the present invention, shown inan expanded state;

FIG. 1B is a cut-away isometric view similar to FIG. 1A cut along acentral longitudinal plane;

FIGS. 2A and 2B are side views of the implant of FIG. 1A shown in aninitial closed state and an expanded state, respectively;

FIG. 3 is an exploded isometric view of the implant of FIG. 1Aadditionally showing a tip of a worm-gear tool for actuating expansionof the implant;

FIGS. 4A and 4B are cross-sectional views taken along a centrallongitudinal plane through the implant of FIG. 1A, the implant beingshown with the worm-gear tool inserted, with the implant shown in itsinitial closed state and its expanded state, respectively;

FIG. 5A is an isometric view of the implant of FIG. 1A attached to adelivery system;

FIG. 5B is an enlarged view of the region of FIG. 5A designated V;

FIGS. 6A-6C are schematic plan views showing the positioning of theimplant of FIG. 1A relative to a vertebra during deployment as alaterally-expandable intervertebral cage, the implant being shown in aninitial compact state connected to a delivery system, in an expandeddeployed state, and after filling and removal of the delivery system,respectively;

FIGS. 7A and 7B are side views of a variant implementation of theimplant of FIG. 1A, shown in an initial closed state and an expandedstate, respectively;

FIG. 8A is an isometric view of an expandable implant, constructed andoperative according to a further embodiment of the present invention,shown in an expanded state;

FIG. 8B is a cut-away isometric view similar to FIG. 8A cut along acentral longitudinal plane;

FIGS. 9A and 9B are side views of the implant of FIG. 8A shown in aninitial closed state and an expanded state, respectively;

FIG. 10A is an isometric view of an expandable implant, constructed andoperative according to a further embodiment of the present invention,shown in an expanded state;

FIG. 10B is a cut-away isometric view similar to FIG. 10A cut along acentral longitudinal plane;

FIGS. 11A and 11B are side views of the implant of FIG. 10A shown in aninitial closed state and an expanded state, respectively;

FIG. 11C is a bottom isometric view of the implant of FIG. 10A;

FIGS. 12A and 12B are schematic plan views showing the positioning ofthe implant of FIG. 10A relative to a vertebra in an initial compactstate and in an expanded deployed state, respectively;

FIG. 13A is an isometric view of an expandable implant, constructed andoperative according to a further embodiment of the present invention,shown in an expanded state;

FIG. 13B is a cross-sectional view taken along a central longitudinalplane of FIG. 13A;

FIGS. 14A and 14B are side views of the implant of FIG. 13A shown in aninitial closed state and an expanded state, respectively;

FIGS. 15A and 15B are schematic plan views showing the positioning ofthe implant of FIG. 13A relative to a vertebra in an expanded deployedstate, the implant being shown in a first orientation and a secondorientation, respectively;

FIGS. 16A and 16B are side views of an expandable implant, constructedand operative according to a further embodiment of the presentinvention, shown in an initial closed state and an expanded state,respectively;

FIGS. 16C and 16D are cross-sectional views taken along a centrallongitudinal plane of FIGS. 16A and 16B, respectively;

FIGS. 17A and 17B are isometric views of the expandable implant of FIGS.16A and 16B, respectively;

FIGS. 18A and 18B are schematic isometric and plan views, respectively,showing positioning of an expandable implant relative to a vertebra inan expanded deployed state according to a variant embodiment foradjusting lordotic angle between vertebral bodies when inserted via aTLIF approach;

FIGS. 19A and 19B are schematic lateral and anterior views,respectively, showing positioning of the expandable implant of FIGS. 18Aand 18B relative to a vertebra in an expanded deployed state wheninserted via a PLIF approach;

FIG. 20 is an isometric view of an expandable implant, constructed andoperative according to a further embodiment of the present invention,shown in an expanded state;

FIGS. 20B and 20C are side views of the implant of FIG. 20A shown in aninitial closed state and an expanded state, respectively; and

FIGS. 21A and 21B are cross-sectional view taken along a centrallongitudinal plane of FIG. 20A in an initial closed state and anexpanded state, respectively.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention is an expandable implant.

The principles and operation of expandable implants according to thepresent invention may be better understood with reference to thedrawings and the accompanying description.

Referring now to the drawings, the present invention will be illustratedherein with reference to a number of exemplary embodiments, principallyincluding a first embodiment illustrated in FIGS. 1A-6C, a secondembodiment illustrated in FIGS. 8A-9B, a third embodiment illustrated inFIGS. 10A-12B, and a fourth embodiment illustrated in FIGS. 13A-15B. Theremaining figures relate to a number of variant implementations andalternative embodiments that will be addressed separately below.

Referring first generically to the above four embodiments, certainpreferred embodiments of the present invention provide an expandableimplant, generally designated 100, 200, 300 and 400, respectively.Analogous features of the different embodiments will be referred to bythe same reference numeral throughout the drawings. In each case, theexpandable implant includes a base 10 and a displaceable element 12. Afirst end portion 14 of base 10 is hingedly interconnected to a firstend portion 16 of displaceable element 12 so as to be pivotable about anaxis 18. Second end portions 20 and 22 of base 10 and displaceableelement 12 are formed with complementary jaws 24 and 26, respectively.According to certain particularly preferred embodiments of the presentinvention, the complementary jaws are configured to provide continuousoverlap over a range of angular positions of the displaceable elementrelative to the base. The particular range of angular positionsaccommodated by the implant while maintaining overlap depends upon theintended application, as will be discussed further below, but in mostcases will be in excess of 10 degrees, and in many cases in excess of 20degrees.

By providing complementary jaws as disclosed herein, it is possible toprovide a particularly simple implant design, with as few as two primarystructural components hinged together at a single pivotal connection,which allows considerable expansion of the implant after delivery intothe body, while maintaining an enclosed volume within the implant forcontaining filling material.

It will be useful to define certain terminology as used herein in thedescription and claims. The present invention relates to an “implant”.The term implant is used herein in the description and claims to referto any implant useful for introducing into a human or animal body,particularly as part of an orthopedic surgical procedure. The inventionwill be exemplified herein with reference specifically to the field ofspinal surgery, and in particular, in applications in which the implantis deployed in the intervertebral space. However, the implant of thepresent invention is not limited to such applications, and may findutility in a range of other spinal and non-spinal procedures. The phrase“expandable implant” refers to an implant which can be expanded oncewithin the body so as to increase its external dimensions in at leastone direction.

Where reference is made to an “enclosed volume”, this refers to a volumewhich lies within a closed loop formed by an implant, preferably so thatthe volume is encompassed on all sides sufficiently to form a barriertending to prevent, or at least limit, dispersion of various types offilling material. The enclosure is typically a two-dimensionalenclosure, meaning that the volume defined by the implant is effectivelyenclosed in a plane of a loop formed by the implant, but is open in adirection perpendicular to that plane. In applications in which theimplant is deployed between inward-facing tissue surfaces, those tissuesurfaces together with the structure of the implant cooperate to definea three-dimensional enclosure. The term “enclosed” does not rule out thepresence of one or more openings or windows formed through one or moreelements of the enclosing structure, which may for example define apreferred direction of controlled release of excess filling material forapplications where such overflow is appropriate. Furthermore, theenclosing structure does not necessarily have a uniform wall heightaround the entire enclosure, and is still considered to “enclose” thevolume so long as it is sufficient to limit dispersion of the fillingmaterial.

The structure of jaws 24 and 26 is referred to variously as providing“complementary facing arcuate surfaces” or “complementary facingsurfaces corresponding to solids of revolution about axis 18”. Thesephrases refer to various geometries of facing surfaces that allow thesurfaces to maintain close proximity over a range of pivotal motionbetween base 10 and displaceable element 12. The surfaces preferablyapproximate closely to an “arcuate contact profile” shaped to maintainsliding contact as the two elements move through relative pivotalmotion. However, in order to accommodate manufacturing tolerances, theelements are typically designed to have a small clearance, preferably ofless than 1 millimeter, and typically of no more than 0.5 millimeter. Itis expected that, under conditions of loading within the body, thesefacing surfaces may in fact come into contact, and serve to providemechanical strength by limiting the strain deformation of the componentsrelative to each other. The facing surfaces may be in various forms,including, but not limited to, partial-cylindrical surfaces centered onaxis 18 and/or planar surfaces perpendicular to axis 18. Other forms ofcontact surface may also be used where the contact surfaces are parts ofa male-female pair of solids of revolution about axis 18. A number ofdifferent examples will be shown in the examples below, and unlessotherwise stated, are interchangeable between the various disclosedembodiments. It should also be noted that any reference to “abutment”between the surfaces does not require that contact occurs in theunstressed state of the implant, but rather that the correspondingfacing surfaces maintain facing overlap over the range of motion.

The implants of the present invention may be implemented using anybiocompatible material with suitable mechanical properties, includingbut not limited to various polymer materials, such as PEEK, ceramicmaterials, and various metals and metal alloys. Certain particularlypreferred implementations are formed primarily, or exclusively, fromtitanium, which combines mechanical strength with good bone integrationproperties.

Referring still generically to expandable implants 100, 200, 300 and400, in certain particularly preferred implementations of the presentinvention, an opening mechanism employed to expand the implant withinthe body is based on the principle of a worm gear engagement.Accordingly, in such embodiments, first end portion 16 of displaceableelement 12 is formed with a plurality of projecting teeth 28 configuredas a partial gear centered on axis 18. Projecting teeth 28 areconfigured for engaging a complementary worm gear.

Turning now specifically to the non-limiting example of expandableimplant 100, this implementation employs a removable worm gear tool aspart of the delivery system which is removed from the body afterexpansion of the implant. To this end, first end portion 14 of base 10is formed with a socket 30 (FIG. 1B) configured for removably receivinga worm gear tool 32 (FIGS. 3, 4A and 4B) which engages teeth 28 in orderto actuate expansion of the implant.

In order to maintain a deployed state of the implant when worm gear tool32 is withdrawn, a locking or retention mechanism is preferablyprovided. A locking mechanism can be implemented in various ways. Oneparticularly simple locking mechanism is the use of a tightenableclamping screw (not shown) mounted in first end portion 14 which bearson end portion 16 in the region of the pivotal connection and locks thedesired relative positions of base 10 and displaceable element 12.However, in some cases, it is preferred to provide a retention mechanismwhich does not require separate actuation, and will retain whateverdegree of expansion of the implant has been achieved.

In an alternative set of implementations, complementary jaws 24 and 26are formed with complementary parts of a retention configurationconfigured for inhibiting return of displaceable element 12 afterexpansion towards an initial closed position. In the particularlypreferred example illustrated here, the retention configuration isimplemented as at least one sequence of ratchet teeth 34, here shown aspart of jaws 26, that are deployed to inhibit return of the displaceableelement from a range of positions of the displaceable element towardsthe initial position by engaging a facing lip 36 of jaws 24 (FIG. 1A).

In the particularly preferred non-limiting example illustrated here,ratchet teeth 34 and facing lip 36 are deployed on surfaces which aregenerally perpendicular to axis 18. As a result, in applications such asthe laterally-expandable intervertebral cage detailed below withreference to FIGS. 6A-6C, load applied to the cage as a result of thenormal axial loading between vertebrae tends to enhance locking of theratchet engagement.

In the case illustrated here, jaw 26 is implemented as a pair ofprojecting portions that are interposed between inward facing surfacesof jaw 24. Jaw 26 could also be implemented as a single contiguous block(as in implant 200 below), except that it is desired to leave a centralvoid to provide access for a ratchet release tool, as further detailedbelow. Additionally, jaw 24 is here implemented with an integrated endwall such that the inward facing surfaces and the end wall encompass theprojecting portions of jaw 26 on three sides. Thus, in the closed stateof the implant, the entire form of the distal tip of the implant isdefined by second end portion 20 of base 10, while second end portion 22of displaceable element 12 is essentially contained within end portion20. This option may in some cases be advantageous as reducinginteraction between the moveable element 12 and surrounding tissueduring deployment, thereby minimizing frictional resistance to openingof the implant.

The hinged interconnection between base 10 and displaceable element 12may be implemented using any suitable hinge engagement configuration. Inthe particularly preferred but non-limiting implementation best seen inFIG. 3, the engagement configuration is formed by pins 52 projectingbilaterally from the sides of first end portion 16 of the displaceableelement which engage complementary sockets or apertures 54 in side wallsof first end portion 14 of the base. In order to facilitate snappingtogether of the hinge structure, pins 52 may be formed with a chamfer 56which helps to momentarily flex apart the sides of the base duringassembly. A reversed configuration, in which pins projecting from thebase engage recesses or a bore in the displaceable element may also beused. Alternatively, a separate hinge pin may be used.

The process of deployment of implant 100 will thus be understood asfollows. With the implant in its initial closed state, it is attached toa hollow shaft 38 of a delivery system 40 via a suitable releasablegripping mechanism (not detailed here). Worm gear tool 32 is insertedthrough delivery system 40 and its handle 42 turned until the wormengages teeth 28 and advances to its fully inserted position, asillustrated in FIG. 4A. A locking mechanism 44 is then engaged to lockworm gear tool 32 against longitudinal motion relative to deliverysystem 40. Insertion of tool 32 can be performed either before or afterinsertion of the implant into the body.

Implant 100 is introduced via a suitable incision, after any requiredpreparatory steps have been performed as is known in the art, so thatthe base is correctly positioned in the target location. Handle 42 isthen rotated in a direction reversed relative to its insertiondirection. Since worm gear tool 32 is locked by locking mechanism 44,the worm gear is unable to retract from the insert, and instead pushesagainst teeth 28, thereby forcing displaceable element 12 to rotatearound axis 18, successively passing one after another of ratchet teeth34 over lip 36. Optionally, worm gear tool 32 and teeth 28 may beconfigured with a left-handed threading direction, if a clockwiserotation is preferred as a more intuitive motion for expanding theimplant.

Once a desired degree of expansion has been achieved, handle 42 ispreferably turned slightly in the reverse direction, to remove loadingfrom the worm gear. Locking mechanism 44 is then released, and worm geartool 32 can be rotated until it disengages from teeth 28 and can becompletely removed from the delivery system.

It will be noted that, after removal of worm gear tool 32, the lumenalong which the worm gear tool was inserted and socket 30, togetherprovide a relatively large access channel, facilitating introduction offilling material even for applications with small dimension accesschannels, such as TLIF or PLIF approaches. This removable worm-gearapproach is believed to be of patentable significance independent of theaforementioned overlap of the jaws 24 and 26. FIGS. 6A and 6B illustratethe stages of operation as described above for a TLIF approach, and FIG.6C illustrates the final deployed implant after filling and removal ofthe delivery system.

In some cases, it may be desired to reposition or remove the implantafter deployment. In such cases, it may be necessary to collapse theimplant back to its closed state. For this purpose, the retentionmechanism is advantageously implemented so as to be selectivelyreleasable. In the implementation shown here, jaw 24 is formed with acentral slot 46, optionally intersecting with an additional aperture 48,which subdivides jaw 24 into two separate resilient elements, eachbearing one of the ratchet-engaging lips 36. By insertion of a suitableprising tool, such as a screw-driver tip (not shown) into slot 46, it ispossible to increase a spacing of the slot, moving lips 36 apartsufficiently to release the ratchet engagement and allow displacement ofdisplaceable element 12 towards its initial position.

Notably, a particularly preferred implementation of expandable implant100 typically consists essentially of only two primary structuralcomponents: base 10 and displaceable element 12, optionally with anadditional hinge pin depending upon the chosen design for the hinge. Thesimplicity of the structure in turn results in reduced costs, increasedreliability, and potentially greater miniaturization for applications inwhich compact dimensions are important.

Expandable implant 100 as illustrated here is particularly adapted foruse as an intervertebral cage which expands laterally, i.e., within theintervertebral disc space, as part of an intervertebral fusionprocedure. In particular, as best seen in FIGS. 3 and 5B, the leadingend of second end portion 20 is here rounded to provide a “bullet nose”effect known to be advantageous for facilitating insertion andminimizing trauma to surrounding tissue during introduction of thedevice into the body. Expandable implant 100 also features lateralridges 50 or other projecting features on the edges of base 10 anddisplaceable element 12 configured to enhance gripping of the adjacentvertebral endplates when the device is deployed.

Turning now to FIGS. 7A and 7B, there is shown a variant implementationof implant 100 labelled 150. Implant 150 is essentially similar instructure and function to implant 100, but differs in that the closedconfiguration of FIG. 7A is formed with a negative angle between theouter surfaces of base 10 and displaceable element 12, i.e., so that itconverges towards end portions 20 and 22, which here form the distal endof the implant. The resulting wedge shape may facilitate introduction ofthe implant into the body, gradually forcing apart the adjacent tissue.After reaching the target location, the implant is expanded to thedesired extent, in the same manner discussed above in relation toimplant 100. Although such a variant is only illustrated here inrelation to implant 100, it should be noted that each of the implantsdiscussed herein may be implemented with an initial closed state whichhas parallel, negatively angled, or positively angled outer surfaces.

Turning now to expandable implant 200, illustrated in FIGS. 8A-9B, thisis generally similar in structure and function to implant 100, withanalogous features labeled similarly. Implant 200 differs from implant100 primarily in that it is implemented using a worm gear 202 whichremains within the body as part of the implant itself. Worm gear 202 isrotatably deployed in a recess 204 within first end portion 14 so as toengage teeth 28. Rotation of worm gear 202 displaces teeth 28 so as torotate the partial gear about axis 18, thereby effecting displacement ofthe displaceable element from the initial closed state of FIG. 9A to theany desired position in the range up to the fully open state of FIG. 9B.A driver-receiving socket 206, in this case a hex-socket, is formed inat least a proximal end of worm gear 202 so as to allow drivingengagement of a suitable driver tool (not shown) with the worm gear.

The pitch angle of worm gear 202 is preferably chosen so as to provideeffective frictional locking of the expandable implant at all pointswithin its range of motion, such that no separate ratchet arrangement orother retention mechanism is typically required. The presence of theworm gear as a part of the implant raises the typical count of mainstructural components of the implant to three, but the structure remainsstrikingly simple, reliable and compact.

In order to facilitate delivery of filling material into an internalvolume of the implant, worm gear 202 is most preferably here implementedas a hollow worm gear formed with an axial through-bore 208. Whendeployed with a delivery system similar to that of FIG. 5A, a drivertool (replacing worm gear tool 42 of that figure) is used to rotate wormgear 202 to achieve a desired degree of expansion. Once the desiredexpansion has been achieved, the driver tool is removed, leaving thedelivery system lumen available and aligned with through-bore 208 forintroduction of filling material via the axial through-bore into theexpandable implant.

In all other respects, the structure and function of expandable implant200 is similar to that of expandable implant 100, and will be understoodby analogy to the above description.

Turning now to expandable implant 300, illustrated in FIGS. 10A-12B,this is generally similar in structure and function to implant 200, withanalogous features labeled similarly. Implant 300 differs from implant200 primarily in that it is implemented with a worm gear deploymentmechanism at its distal end rather than its proximal end.

Specifically, expandable implant 300 includes a worm gear 302 rotatablydeployed in a recess 304 within first end portion 14 so as to engageteeth 28. Rotation of worm gear 302 displaces teeth 28 so as to rotatethe partial gear about axis 18, thereby effecting displacement of thedisplaceable element from the initial closed state of FIG. 11A to theany desired position in the range up to the fully open state of FIG.11B. In this case, a driver-receiving socket 306, implemented here as ahex-socket, is formed in the inward-facing end of worm gear 302, and iscomplemented by an aperture 308 formed in the second end portion 20 ofthe base and aligned with driver-receiving socket 306 so as to allowdriving engagement of a suitable driver tool (not shown) with worm gear302. For this purpose, jaw 26 is here implemented as a forked elementwith a central gap aligned with aperture 308, as in implant 100 above.

Positioning of the deployment mechanism at the distal end of implant 300generates a deployment geometry with expansion occurring primarily atthe proximal end of the implant when deployed, in contrast to theprimarily distal expansion of FIGS. 6B and 6C. A typical position ofdeployment of implant 300 via a TLIF approach, prior to and afterexpansion, is shown schematically in FIGS. 12A and 12B, respectively.

In this embodiment, it is first end portion 14 of base 10 that forms theleading (distal) end of the implant during insertion. First end portion14 is therefore preferably formed with a rounded or “bullet-nose”profile, as best seen in FIG. 11C, in order to facilitate the insertion.

In all other respects, the structure and function of expandable implant300 is similar to that of expandable implant 200, and will be understoodby analogy to the above description.

Turning now to expandable implant 400, illustrated in FIGS. 13A-15B,this implant is conceptually a combination of features from implants 200and 300, with analogous features labeled similarly. Implant 400 differsfrom implants 200 and 300 primarily in that it provides accessibilityfor operating worm gear 202 from either end of the implant, therebyallowing the user to choose whether to deploy the implant with the wormgear mechanism at the proximal or distal end of the implant.

Thus, expandable implant 400 shares with implant 200 a worm gear 202deployed in a recess 204 with a through-bore 208 which typically isimplemented with a hex-socket cross-section so as to serve also as abidirectional driver-receiving socket. In addition, second end portion20 of the base is preferably formed with an aperture 308 aligned withworm gear 202 so as to allow insertion of a tool through the aperture toengage the worm gear for rotating the worm gear.

As a result of this structure, expandable implant 400 can be usedreversibly, according to the requirements of a particular procedure andthe preferences of a particular surgeon. FIG. 15A illustratesschematically a deployed position of expandable implant 400 relative toa vertebral endplate via a TLIF approach when the worm gear mechanism isdeployed proximally so as to expand primarily at its distal end. FIG.15B illustrates schematically a deployed position of expandable implant400 relative to a vertebral endplate via a TLIF approach when the wormgear mechanism is deployed distally so as to expand primarily at itsproximal end.

Expandable implant 400 also illustrates a further variant implementationof overlapping jaws 24 and 26. In contrast to the above embodiments inwhich jaw 26 is typically circumscribed on three sides by jaw 24, jaw 26is here implemented a structure which extends the full width of theimplant, with a forked structure which straddles a connecting region 402of base 10, as best seen in FIG. 13A. In the non-limiting exampleillustrated here, jaw 24 is implemented as an end plate with an arcuateinside surface in facing relation to the arcuate outer surface of jaw26.

In all other respects, the structure and function of expandable implant400 is similar to that of expandable implants 200 and 300, and will beunderstood by analogy to the preceding description.

Turning now to FIGS. 16A-17B, these illustrate a variant implementationof expandable implant 200, designated expandable implant 250. Implant250 is essentially similar in structure and function to implant 200,with analogous elements labeled similarly. Implant 250 differs fromimplant 200 primarily in the structure of jaws 24 and 26, which are herearranged as arcuate nested elements with jaw 26 closer to axis 18 andjaw 24 further from the axis. This arrangement allows both jaws toextend across the entire width of the implant. In certain cases, thisconfiguration may provide advantages when used as a laterally expandableintervertebral cage if it is desired to provide enhanced support ofaround the entire periphery of the cage when deployed.

Parenthetically, although illustrated herein with a generally uniformwidth, the width dimension of implants according to the presentinvention may be varied according to the needs of each particularapplication. For example, in the case of a laterally expandable cage, itmay be desirable to vary the width of the implant along its length inorder to better fit the implant to the physiological shape of thevertebral endplates.

Turning now to FIGS. 18A-19B, although illustrated thus far in theexemplary context of an implant expanding laterally, within an axialplane, it should be noted that the implants of the present invention arenot limited to this application, and can equally be used for a range ofadditional orthopedic applications, whether in spinal surgery orelsewhere in the body. By way of one further subset of non-limitingexamples, FIGS. 18A-19B illustrate a modified version of implant 100,here designated 160, configured for use as an angle-correcting implantfor adjusting a lordotic angle and/or a scoliosis angle between adjacentvertebral endplates. In this case, instead of providing ridges 50 alongthe lateral edges of the components, base 10 and displaceable element 12are here provided with ridges 162 or other projecting features for boneengagement on the major outward facing surfaces of the base anddisplaceable element. FIGS. 18A and 18B illustrate deployment ofexpandable implant for restoration of lordotic angle via a TLIFapproach, while FIGS. 19A and 19B illustrate deployment via a PLIFapproach.

The angular range of motion for which each of the above examples isdesigned varies according to the requirements of each application. Forlordotic or scoliosis angle correction, in some cases, angular ranges ofup to 8 degrees may be sufficient. In many cases, it is desirable toprovide larger ranges of adjustment, preferably in excess of 10 degrees,and in many cases of 20 degrees or more. Particularly for laterallyexpandable cage implementations, a maximum opening angle in the range of20-30 degrees may be preferred.

Referring finally to FIGS. 20A-21B, there is shown an expandableimplant, generally designated 500 which exemplifies an alternativeapproach to maintaining an enclosed volume within the implant duringangular deployment of a displaceable element 12 relative to a base 10.The features of implant 500 are generally similar to those of implant200 described above, and analogous features are labelled similarly. Inthis case, instead of overlapping jaws, second end portion 20 of base 10is formed with a hollow block 502 that houses a channel 504 within whichis housed a flexible strip 506. One end of flexible strip 506 isfastened to second end portion 22 of displaceable element 12 so that thestrip is drawn out and deployed as displaceable element 12 opens awayfrom base 10. Optionally, a mechanism (not shown) may be deployed tomaintain tension in the strip.

To the extent that the appended claims have been drafted withoutmultiple dependencies, this has been done only to accommodate formalrequirements in jurisdictions which do not allow such multipledependencies. It should be noted that all possible combinations offeatures which would be implied by rendering the claims multiplydependent are explicitly envisaged and should be considered part of theinvention.

It will be appreciated that the above descriptions are intended only toserve as examples, and that many other embodiments are possible withinthe scope of the present invention as defined in the appended claims.

What is claimed is:
 1. An expandable implant comprising: a baseextending from a first end portion to a second end portion; and adisplaceable element extending from a first end portion to a second endportion, wherein said first end portions of said base and saiddisplaceable element are hingedly interconnected, and wherein saidsecond end portions of said base and said displaceable element areformed with complementary jaws, said complementary jaws being configuredto provide continuous overlap over a range of angular positions of saiddisplaceable element relative to said base; wherein a first jaw of saidcomplementary jaws comprises at least one projecting portion that isinterposed between inward facing surfaces of a second of saidcomplementary jaws; wherein said displaceable element is displaceablerelative to said base from an initial position defining a compactconfiguration of the expandable implant towards a deployed positiondefining an expanded configuration of the expandable implant, andwherein said complementary jaws are formed with complementary parts of aretention configuration configured for inhibiting return of saiddisplaceable element towards said initial position; and wherein saidretention configuration comprises two resilient retention elementsseparated by a slot, and wherein said retention configuration isconfigured such that, on insertion of a prising tool into said slot toincrease a spacing of said slot, said retention configuration isreleased to allow displacement of said displaceable element towards saidinitial position.
 2. The expandable implant of claim 1, wherein saidcomplementary jaws provide complementary facing arcuate surfaces.
 3. Theexpandable implant of claim 1, wherein said complementary jaws providecomplementary facing surfaces forming solids of revolution about an axisof said hinged interconnection.
 4. The expandable implant of claim 1,wherein said inward facing surfaces are integrated with an end wall suchthat said inward facing surfaces and said end wall encompass said atleast one projecting portion on three sides.
 5. The expandable implantof claim 1, wherein said complementary jaws are configured to providesaid continuous overlap over a range of angular positions of saiddisplaceable element relative to said base spanning at least 10 degrees.6. The expandable implant of claim 1, wherein said complementary jawsare configured to provide said continuous overlap over a range ofangular positions of said displaceable element relative to said basespanning at least 20 degrees.
 7. The expandable implant of claim 1,wherein said first end portion of said displaceable element is formedwith a plurality of projecting teeth configured as a partial gearcentered on an axis of the hinged interconnection with said base, saidprojecting teeth being configured for engaging a worm gear.
 8. Theexpandable implant of claim 7, wherein said first end portion of saidbase is formed with a socket configured for removably receiving a wormgear tool for engaging said teeth and displacing said displaceableelement.
 9. The expandable implant of claim 7, further comprising a wormgear rotatably deployed within said first end portion of said base inengagement with said teeth such that rotation of said worm gear effectsdisplacement of said displaceable element, wherein said worm gear is ahollow worm gear formed with an axial through-bore for introduction offilling material via said axial through-bore into the expandableimplant.
 10. The expandable implant of claim 9, wherein said second endportion of said base is formed with an aperture aligned with said wormgear so as to allow insertion of a tool through said aperture to engagesaid worm gear for rotating said worm gear.
 11. The expandable implantof claim 1, wherein said retention configuration comprises at least onesequence of ratchet teeth deployed to inhibit return of saiddisplaceable element from a range of positions of said displaceableelement towards said initial position.
 12. The expandable implant ofclaim 7, further comprising a worm gear rotatably deployed within saidfirst end portion of said base in engagement with said teeth such thatrotation of said worm gear effects displacement of said displaceableelement, and wherein said second end portion of said base is formed withan aperture aligned with said worm gear so as to allow insertion of atool through said aperture to engage said worm gear for rotating saidworm gear.
 13. An expandable implant comprising: a base extending from afirst end portion to a second end portion; and a displaceable elementextending from a first end portion to a second end portion, wherein saidfirst end portions of said base and said displaceable element arehingedly interconnected, and wherein said second end portions of saidbase and said displaceable element are formed with complementary jaws,said complementary jaws being configured to provide continuous overlapover a range of angular positions of said displaceable element relativeto said base; wherein said first end portion of said displaceableelement is formed with a plurality of projecting teeth configured as apartial gear centered on an axis of the hinged interconnection with saidbase, said projecting teeth being configured for engaging a worm gear; aworm gear rotatably deployed within said first end portion of said basein engagement with said teeth such that rotation of said worm geareffects displacement of said displaceable element, wherein said wormgear is a hollow worm gear formed with an axial through-bore forintroduction of filling material via said axial through-bore into theexpandable implant; and wherein said second end portion of said base isformed with an aperture aligned with said worm gear so as to allowinsertion of a tool through said aperture to engage said worm gear forrotating said worm gear.
 14. The expandable implant of claim 13, whereinsaid complementary jaws provide complementary facing arcuate surfaces.15. The expandable implant of claim 13, wherein said complementary jawsprovide complementary facing surfaces forming solids of revolution aboutan axis of said hinged interconnection.
 16. The expandable implant ofclaim 13, wherein said displaceable element is displaceable relative tosaid base from an initial position defining a compact configuration ofthe expandable implant towards a deployed position defining an expandedconfiguration of the expandable implant, and wherein said complementaryjaws are formed with complementary parts of a retention configurationconfigured for inhibiting return of said displaceable element towardssaid initial position.
 17. An expandable implant comprising: a baseextending from a first end portion to a second end portion; and adisplaceable element extending from a first end portion to a second endportion, wherein said first end portions of said base and saiddisplaceable element are hingedly interconnected, and wherein saidsecond end portions of said base and said displaceable element areformed with complementary jaws, said complementary jaws being configuredto provide continuous overlap over a range of angular positions of saiddisplaceable element relative to said base; wherein said first endportion of said displaceable element is formed with a plurality ofprojecting teeth configured as a partial gear centered on an axis of thehinged interconnection with said base, said projecting teeth beingconfigured for engaging a worm gear; a worm gear rotatably deployedwithin said first end portion of said base in engagement with said teethsuch that rotation of said worm gear effects displacement of saiddisplaceable element, and wherein said second end portion of said baseis formed with an aperture aligned with said worm gear so as to allowinsertion of a tool through said aperture to engage said worm gear forrotating said worm gear.
 18. The expandable implant of claim 17, whereinsaid complementary jaws provide complementary facing arcuate surfaces.19. The expandable implant of claim 17, wherein said complementary jawsprovide complementary facing surfaces forming solids of revolution aboutan axis of said hinged interconnection.
 20. The expandable implant ofclaim 17, wherein said displaceable element is displaceable relative tosaid base from an initial position defining a compact configuration ofthe expandable implant towards a deployed position defining an expandedconfiguration of the expandable implant, and wherein said complementaryjaws are formed with complementary parts of a retention configurationconfigured for inhibiting return of said displaceable element towardssaid initial position.